Treatment
Treatments for anemia depend on severity and cause. Treatment by oral administration of iron in the form of ferrous sulphate tablets. This must be continued for 4-6 months to replenish iron stores. Any underlying cause should be treated. Parenteral iron is used if the patient has malabsorption or cannot tolerate oral preparation.
Iron deficiency from nutritional causes is rare in non-menstruating adults (men and post-menopausal women). The diagnosis of iron deficiency mandates a search for potential sources of loss such as gastrointestinal bleeding from ulcers or colon cancer. Mild to moderate iron deficiency anemia is treated by oral iron supplementation with ferrous sulfate, ferrous fumarate, or ferrous gluconate.
When
taking iron supplements, it is very common to experience stomach upset and/or
darkening of the feces. The stomach upset can be alleviated by taking the iron
with food; however, this decreases the amount of iron absorbed. Vitamin C aids
in the body's ability to absorb iron, so taking oral iron supplements with
orange juice is of benefit. Vitamin supplements given orally (folic acid) or
subcutaneously (vitamin B-12) will replace specific deficiencies.
In
anemia of chronic disease, anemia associated with chemotherapy, or anemia
associated with renal disease, some clinicians prescribe recombinant
erythropoietin, epoetin alfa, to stimulate red cell production. In severe cases
of anemia, or with ongoing blood loss, a blood transfusion may be necessary.
If
anemia does not respond to oral treatments, it may be necessary to administer
iron parenterally (e.g., as iron dextran) using a drip or hemodialysis.
Parenteral iron involves risks of fever, chills, backache, myalgia, dizziness,
syncope, rash and anaphylactic shock.
A
follow up blood test is essential to demonstrate whether the treatment has been
effective.
Iron
supplements should be kept out of the reach of children, as iron-containing
supplements are a frequent cause of poisoning in children.
Types of Parenteral Irons
Iron injections are administered either directly into the blood stream through an IV line or into the muscle. Unlike oral supplements, iron injections need to be administered by a trained professional in a clinic or hospital.
There
are different types of solutions containing iron that can be injected into the
circulatory system or muscle to raise iron levels in the body. The appropriate
type, amount, and frequency of iron injections are determined for each
individual patient based on the severity of the iron deficiency and the ability
to tolerate the treatment.
Iron injections comprise four major types:
- iron sucrose
- iron dextran
- sodium ferric gluconate
- ferumoxytol
Iron infusion vs. iron injection
Iron supplements types:
- ferrous sulfate.
- ferrous gluconate.
- ferric citrate.
- ferric sulfate.
Oral
Iron dosing:
Calculate
doses using mg of elemental iron
- Mild anemia or latent iron deficiency – 3 mg/kg daily
- Severe anemia – 4-6 mg/kg divided BID
- Adolescents – 2-3 mg/kg/day
Enteral Vs Parenteral Replacement
Advantages
of enteral replacement:
- Effective when taken properly and tolerated
- Initial cost is low
- Low risk of allergic reactions
- Low risk of serious adverse events
- Advantages of parenteral replacement:
- Quickest resolution
- Rapid improvement in symptoms
- Compliance
- Fewer clinic visits
- No GI complaints